Objectives:

1. Concept of transcultural nursing

2. Components of cultural assessment
3. Theories applicable to transcultural nursing
4. Role of family and cultural practices
Q no 1: Trans-cultural nursing

• Transcultural Nursing is a specialty with in Nursing focused on the

comparative study and analysis of different cultures and subcultures.
• Various groups are examined with respect to their caring behavior,
nursing care, health and illness values, beliefs and patterns of
behavior.
Q no 1 (a): Related concepts:

• Transcultural nursing is a comparative study of cultures to

understand similarities (culture universal) and difference (culture-
specific) across human groups (Leininger, 1991).
• Culture: Norms and practices of a particular group that are learned
and shared and guide thinking, decisions, and actions.
• Cultural values: The individual's desirable or preferred way of
acting or knowing something that is sustained over a period of time
and which governs actions or decisions.
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• RELIGION: Is a set of belief in a divine or super human power (or powers)
to be obeyed and worshipped as the creator and ruler of the universe.
• ETHNIC: Refers to a group of people who share a common and distinctive
culture and who are members of a specific group.
• CULTURAL IDENTIFY: The sense of being part of an ethnic group or
culture.
• CULTURE-UNIVERSALS: Commonalities of values, norms of behavior,
and life patterns that are similar among different cultures.
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• CULTURE-SPECIFIES: Values, beliefs, and patterns of behavior

that tend to be unique to a designate culture.
• MATERIAL CULTURE: Refers to objects (dress, art, religion)
• NON-MATERIAL CULTURE: Refers to beliefs customs,
languages, social institutions.
• DIVERSITY: refers to the fact or state of being different. Diversity
can occur between cultures and within a cultural group
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• ACCULTURATION: People of a minority group tend to assume the

attitudes, values, beliefs, find practices of the dominant society
resulting in a blended cultural pattern.
• SUBCULTURE: composed of people who have a distinct identity
but are related to a larger cultural group.
• BICULTURAL: a person who crosses two cultures, lifestyles, and
sets of values.
Q no 1: (b) Components of cultural assessment

• The Transcultural Assessment Model of Giger and Davidhizar’s

is a tool developed to assess cultural values of patients about
health and disease behaviors and their effects.
• The model contains six cultural dimensions: Communication,
Space, Social Organizations, Time, Environmental Control, and
Biological Variations.
1. Communication is the means by which culture is transmitted and
preserved. Both verbal and nonverbal communications are learned in
one’s culture. Verbal and nonverbal patterns of communication vary
across cultures, and if nurses do not understand the client’s cultural
rules in communication, the client’s acceptance of a treatment
regimen may be jeopardized.
2. Space: refers to the distance between individuals when they interact.
All communication occurs in the context of space.  There are four
distinct zones of interpersonal space:
1) inmate zone (extends up to 1 ½ feet),
2) personal distance (extends from 1 ½ to 4 feet),
3) social distance (extends from 4 to 12 feet)
4) public distance (extends 12 feet or more)
3. Social organization: Social organization refers to the social group
organizations with which clients and families may identify.
4. Time Orientation: Time is an important aspect of interpersonal
communication. Some cultures are considered future oriented, others present
oriented, and still others past oriented
5. Environmental control: refers to the ability of the person to control nature
and to plan and direct factors in the environment. Some groups perceive man as
having mastery over nature; others perceive humans to be dominated by nature,
while others see harmonious relationships between humans and nature
6. Biological variation:
 body structure
 skin colour
 enzymatic and genetic variations
susceptibility to disease
nutritional preferences and deficiencies
psychological characteristics
Q no 2: Madeleine Leininger
• The founder of the theory of Transcultural Nursing / Culture Care
Theory
• Her theory has now developed as a
discipline in nursing
• Theoretical framework is depicted in her
model called the Sunrise Model (1997)
Theoretical source:

• Derived from the discipline of anthropology; conceptualized the

theory to be relevant to nursing
• TRANSCULTURAL NURSING - is a comparative study of cultures
to understand similarities (culture universal) and difference (culture
specific) across human groups (Leininger, 1991).
Nursing Decisions

• Leininger (1991) identified three nursing decision and action modes to

achieve culturally congruent care.
• Cultural preservation or maintenance.
• Cultural care accommodation or negotiation.
• Cultural care repatterning or restructuring.
MAJOR ASSUMPTIONS

• Illness and wellness are shaped by various factors including perception

and coping skills, as well as the social level of the patient.
• Cultural competence is an important component of nursing.
• Culture influences all spheres of human life. It defines health, illness,
and the search for relief from disease or distress.
• Religious and Cultural knowledge is an important ingredient in health
care.
• The health concepts held by many cultural groups may result in people
choosing not to seek modern medical treatment procedures.
• Health care provider need to be flexible in the design of programs,
policies, and services to meet the needs and concerns of the culturally
diverse population, groups that are likely to be encountered.
• Most cases of lay illness have multiple causalities and may require
several different approaches to diagnosis, treatment, and cure
including folk and Western medical interventions.
• The use of traditional or alternate models of health care delivery is widely
varied and may come into conflict with Western models of health care
practice.
• Culture guides behavior into acceptable ways for the people in a specific
group as such culture originates and develops within the social structure
through inter personal interactions.
• For a nurse to successfully provide care for a client of a different cultural or
ethnic background, effective intercultural communication must take place.
APPLICATION TO NURSING

• To develop understanding, respect and appreciation for the

individuality and diversity of patients beliefs, values, spirituality and
culture regarding illness, its meaning, cause, treatment, and outcome.
• To encourage in developing and maintaining a program of physical,
emotional and spiritual selfcare introduce therapies.
The Sunrise Model
• Symbolizes the “rising of the sun (care)” • The upper half of the circle depicts
components of the social structure and world view factors that influence care
and health through language and environment. These factors influence the folk,
professional, and nursing system(s), which are in the lower half of the model.
• The two halves together form a full sun, which represents the universe that
nurses must consider to appreciate human care and health.
• The nursing subsystem can act as a bridge between the folk and personal health
systems through the three types of nursing care actions: cultural care
preservation, cultural care accommodation, and cultural repatterning.
HEALTH PRACTICES IN DIFFERENT
CULTURES
• Use of Protective Objects
• Use of Substances
• Religious Practices
• Traditional Remedies
• Healers
• Immigration
• Gender Roles
• Beliefs about mental health
• Economic Factors
• Time Orientation
• Personal Space
Cultural issues:
• One of the most common cultural issues that arise for nurses
involves faith and religious beliefs.
• Certain religious groups might refuse prescription medications,
blood transfusions, surgeries, or other potentially life-saving
treatments because of their religious beliefs.
• Nurses may struggle to understand these beliefs and may disagree
with the patient’s decision to decline treatment, which is why
developing sensitivity towards various religious beliefs is so
important.
Q no 3:

•  Cross-cultural psychology explores the causal influence of culture on

differences in children’s development, treated as dependent variables. 
Role of culture in developmental stages

• The manner and sequence of the growth and development

phenomenon are universal and fundamental features of all children ;
however, children’s varied behavioral responses to similar events are
often determined by their culture.
• Culture plays a critical role in the parenting behaviors that facilitate
children’s development.
• Children acquire the skills, knowledge, beliefs, and values important
to their own family and culture.
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• Cultural backgrounds can influence the pace of acquisition of

cognitive and motor skills as well as the child’s social and emotional
development.
• Children’s play and their types of games are culturally determined.
• A set of values learned in childhood is likely to characterize children’s
attitudes and bahaviour for life, influencing their long-range goals and
their short range, impulsive inclinations. Thus, every ongoing society
socializes each succeeding generation to its cultural heritage.
Role of family

• Parents in different cultures also play an important role in moulding

children’s behavior and thinking patterns. Typically, parents are the
ones who prepare the children to interact with wider society.
Children’s interaction with their parents often acts as the archetype of
how to behave around others – learning a variety of socio-cultural
rules, expectations and taboos. For example, young children typically 
develop a conversational style resembling their parents’ – and that
often depends on culture.